A TEACHING HOSPITAL OR AN ACADEMIC MEDICAL CENTER (HOSPITAL) ?

LOKMAN SAIM

HOSPITAL

• General hospital• University hospital• Teaching hospital• Public hospital• Private hospital• ? Academic hospital

HOSPITAL AND TEACHING ACTIVITIES

• University Hospital– Hospital that belongs to a university – with a

medical/health sciences schools• Teaching Hospital– Any hospital that is used for teaching activities

• Academic Medical Center (Hospital)– What is an academic medical center ?– Patient centered, student centered

CURRENT TREND• A need for stronger cooperation and

partnership in health service and education• Integration of vision, mission, objectives and

organizational structure to support service, teaching and research

• Evolution of Academic Medical Center or Academic Hospital

ACADEMIC MEDICAL CENTER

• DEFINITION :Institution that integrates one or more hospitals or health systems , a medical school, and one or more other health professional schools.Integrated center with tripartite missions– Excellent medical and health services– Excellent education– Excellent research– One vision and leadership.

MINISTRY OF HEALTH HOSPITALS… teaching hospital but ? an academic hospital

• Hospitals – Ministry of Health

• Medical Schools – University, Ministry of Higher Education

• Differing policies• Differing priorities

– Student vs patient– Dean vs Hospital Director

• WHAT ABOUT PRIVATE HOSPITAL?

… TRANSFORMATION TO AN ACADEMIC HOSPITAL

• Strong leadership engagement• Accept symbiotic relationship between

excellent clinical care, scientific research and medical/health education.

• orient and organize the more broad hospital activities

• Adopt a confluence of policy….Patients, staffs,….. students and trainees.

TRANSFORMATION IN HEALTHCARE

• The Johns Hopkins Hospital and Health System• For more than a century, Johns Hopkins has been

recognized as a leader in patient care, medical research and teaching. Today, Johns Hopkins Medicine is known for its excellent faculty, nurses and staff specializing in every aspect of medical care. The Johns Hopkins Health System includes three acute-care hospitals and programs for local, national and international patient activities

TRANSFORMATION IN HEALTHCARE

• Imperial named Academic Health Science Centre• Imperial College London and Imperial College Healthcare NHS Trust

today welcomed the Department of Health’s formal designation of their partnership as an Academic Health Science Centre (AHSC).

• AHSC status has been awarded to just five partnerships in the UK, and designation signals international excellence in biomedical research, education and patient care. The prestigious AHSC status was awarded after a rigorous six-month review process led by an all-international scrutiny panel of medical experts.

• Imperial College Healthcare NHS Trust and Imperial College London have been working together as an AHSC since October 2007 following the merger of Hammersmith and St Mary’s NHS Trusts and the new Trust’s integration with Imperial College London.

TRANSFORMATION IN HEALTHCRE• National University Health System (NUHS) • is an academic medical centre located in Singapore.

It was established in January 2008 as a joint venture between the National University of Singapore and Singapore's MOH Holdings Pte Ltd. NUHS groups the National University Hospital (NUH) with the National University of Singapore's (NUS) Yong Loo Lin School of Medicine and Faculty of Dentistry under a common governance structure in order to develop and promote academic medicine.

ACADEMIC MEDICAL CENTER

• There are currently AMCs in operation in Canada, the Netherlands, Singapore, Sweden, the United Kingdom and the United States.[2]

• The 16 highest ranked hospitals in the U.S. were all AMCs.[2]

POLICIES ON PATIENTS, STUDENTS AND TRAINEES

• policies need to be developed and serve as the foundation for the hospital administration commitment towards becoming an academic hospital

• the policies should engage a broad range of stakeholders to create clear expectations for the shared mission of excellent patient care, education and research

• policies will align goals of patient care with the academic programmes of teaching, training and research.

HOSPITAL POLICY ON STUDENTS AND TRAINEES

• most vulnerable group of individuals, often sidelined by hospital administrators

• consistency with educational objectives • guidelines for acceptable standards of

professional behaviour– Expected students behavior

• provide parameters for safe clinical practice– personal health and safety

POLICY ON FACILITIES

• Students facilities• Academic facilities • Use of the computers, internet• Clinic rooms for students/trainees clerking of

patients• Use of specific diagnostic instruments –

endoscopes, microscopes, etc

SPECIFIC CONSIDERATION IN PRIVATE HOSPITALS

• TRANSFORMATION AND INNOVATIONS• Number of students/trainees– Small number, distribution to a group of hospitals

• Ratio of trainee : trainer– One-to-one apprenticeship training

• Consent for training activities• Competency-based training• Close supervision by trainer

ACADEMIC MEDICAL CENTER IN KPJ?

NILAI SPECIALIST HOSPITAL(KPJUC ACADEMIC MEDICAL CENTER)

MISSION

KPJ HEALTHCARE BHD aspires to continue as the forerunner and leader in healthcare delivery and the development of innovative, efficient and effective health care education and research . An important factor for this mission is the provision and development of the physical resources that are able to support the expected outcomes of this mission. One of the key infrastructure is the establishment of an ACADEMIC MEDICAL CENTER.

THE CONCEPTThe new facilities will physically demonstrate the platform and extent of integration between all the academic faculties, teaching hospital and research facilities. This is to be achieved through the creation of integrated, interdisciplinary and modern teaching hospital, laboratories and health clinics that will support the developing and demanding needs of undergraduate, graduate, clinical and research work. The facilities should be able to sustain program integration and interdisciplinary health care in an environment of team health care delivery.

PRINCIPLES OF IMPLEMENTATION

• A dedicated academic medical center for excellent patient care, education and research.

• Team approach in patient care – involving medical physicians, healthcare professionals and other supportive care providers.

• Break the traditional individual practice in private hospitals.

• Recalibrate institutional structure – teaching, research and health services based on multidisciplinary centers of excellence under one organizational structure.

FOLLOW CURRENT TREND

• Partnership in health service, education and research

• Team practice rather than individual practice• Stronger cooperation between disciplines in

healthcare (multi-disciplinary care)• Evolution of Academic Medical Center or

Academic Hospital.

BUILDING FEATURES

• 200 bed hospital• Standard features of a private specialist hospital• Medical consultants– Cluster clinics, including for student clerking– Consultant cluster/division office

• Medical officers– Medical officer/ master student room– On call rooms

BUILDING FEATURES

• Students– Student center– Tutorial rooms

• Clinical examination ward– convertible to normal ward

• Tele-video conference facilities• Clinical Skills laboratory• Research Center

HUMAN RESOURCESpecialty No

1. General Medicine 3

2. General Surgery 2

3. Paediatrics 2

4. Obstetrics and Gynecology 2

5. Orthopedics 2

6. ENT 1

7. Opthalmology 1

8. Psychiatry 1

9. Family medicine 2

10. Emergency medicine 1

11 Anaesthesiology 2

12. Radiology 1

HUMAN RESOURCE : NEW CONCEPTS

• Salaried clinicians• Dual employment : Employment by KPJUC and

Hospital• Lecturer functioning as clinician • Clinicians– Lecturer/specialist (40%)– Associate Prof. / consultant) (30%)– Professor/ Senior consultant (30%)

ACADEMIC HEALTH CENTER MODEL IN MALAYSIA

• There is no private academic medical center model in Malaysia.

• No financial model yet.

There are currently AMCs in operation in Canada, the Netherlands, Singapore, Sweden, the United Kingdom and the United States.[2] Highest ranked hospitals in the U.S. were all AMCs.[2]

CHALLENGES

• Acceptance of the ‘tri-partite’ mission of a private medical center – integration of excellent healthcare, teaching and research.

• To break the tradition of “individual private practice” in private hospitals.

• Salaried medical consultants practicing as a team in private hospitals.

• Public perception towards teaching and research activities in private hospitals.

• No financial model in Malaysia.

OPPORTUNITIES• KPJ Healthcare Bhd as an established healthcare institution -

providing leadership role in academic medical center in the region.• Numerous private academic medical centers in USA and as models

eg. Mayo Clinics, John Hopkins• KPJUC clinical lecturers as clinician, academician and researcher.• Potential for trainees sponsored by KPJ Healthcare in the medical

specialty training programme (Master’s programme) as clinical lecturers.

• Very competitive places for training of MOs in Malaysia – better opportunities for practice and training in private medical centers.

CONCLUSION• Transformation into academic hospitals • Engagement in patient care, education and research• Private hospitals and professional talents in private

hospitals have great potential in contributing to education and training of health professionals

• Have clear and effective trainee and student policy – inclusion of stakeholders in its formulation

• Implement policies that provide parameters for excellent patient care and facilitate education and training.

• Consistency in education and clinical training provides good guidelines for trainee’s personal and professional development

• “Inclusive” policies make students and trainees become more aware of their personal responsibility and accountability and realize that they are part of the larger hospital community responsible for the care of the patient.

CONCLUSION

• KPJ ACADEMIC MEDICAL CENTER (KPJ NILAI SPECIALIST HOSPITAL) can be the first private institution that will be able to offer comprehensive, cutting edge patient care, have large and excellent translational research as well as trains the health care professionals of the future.

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